medwireNews: Among people with early type 2 diabetes, levels of C-peptide are more strongly associated with the risk for future cardiovascular (CV) events than levels of C-reactive protein (CRP), research suggests.
Conversely, CRP may represent a stronger predictor of mortality risk than C-peptide, Alisa Kjærgaard (Aarhus University Hospital, Denmark) told delegates at the 58th EASD Annual Meeting in Stockholm, Sweden.
To investigate the association of these two biomarkers with adverse outcomes, the researchers analyzed the DD2 Danish cohort of people with recently diagnosed type 2 diabetes and no history of hospitalization for CV events. Baseline serum high-sensitivity CRP levels – a marker of inflammation – were measured in 7301 individuals, while C-peptide levels, indicating the degree of insulin resistance, were measured in 5765.
When participants were divided into three groups based on CRP levels, those in the highest group (CRP >3 mg/L) had a significantly greater risk for CV events during a median follow-up of 4.8 years than those in the lowest group (CRP <1 mg/L), at rates of 5.4% versus 4.4% and a hazard ratio (HR) of 1.39 after adjustment for potential confounders and C-peptide levels.
CRP levels were also strongly associated with mortality risk; 8.2% of people with the highest CRP levels died during the study, compared with 4.1% of those with the lowest levels, resulting in an adjusted HR of 2.40.
To evaluate the joint impact of the two biomarkers on the risk for CV events and mortality, Kjærgaard et al categorized the cohort into four groups according to whether they had high (>3 mg/L) or low (≤3 mg/L) CRP levels, and high (≥1.47 nmol/L) or low (<1.47 nmol/L) C-peptide levels.
When people with low CRP and low C-peptide were used as the reference group, the highest risk for CV events was seen in people with high levels of both biomarkers (HR=1.61), but people with elevated C-peptide alone (HR=1.54) had a greater increase in risk compared with those with elevated CRP alone (HR=1.37).
For all-cause mortality, the greatest risk increase was also seen among people with elevated CRP and C-peptide (HR=2.36 vs those with low levels of both biomarkers). However, in contrast to the results for CV events, people with elevated CRP alone had a greater risk increase than those with elevated C-peptide alone (HR=1.90 vs 1.15).
Therefore, “C-peptide is a better marker of future risk of cardiovascular disease, whereas CRP is a better marker of increased risk of all-cause mortality,” summarized the presenter
“This emphasizes the need to treat insulin resistance in prevention of cardiovascular events,” she concluded.
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